Bladder Cancer: A Complete Guide

Bladder cancer is classified by the type of cell where the cancer originates and by how deeply it has penetrated the bladder wall. Understanding the type and stage helps doctors determine the most effective treatment. By cell type:

• Transitional cell carcinoma (also called urothelial carcinoma) is by far the most common type, accounting for about 90 percent of all bladder cancers. It begins in the transitional cells that line the inside of the bladder. These cells are able to stretch and change shape as the bladder fills and empties.
• Squamous cell carcinoma accounts for about 5 percent of cases. It develops in thin, flat squamous cells that can form in the bladder after long-term irritation or infection, such as from repeated urinary tract infections or long-term catheter use.
• Adenocarcinoma accounts for about 2 percent of bladder cancers. It begins in glandular cells that produce mucus and is usually linked to chronic inflammation.
• Small cell carcinoma is rare and fast-growing. It starts in nerve-like cells and is typically treated with chemotherapy rather than surgery.
• Sarcoma of the bladder is extremely rare, originating in the muscle cells of the bladder wall.

By depth of invasion (staging):

• Stage 0: The cancer is only in the innermost lining of the bladder and has not invaded deeper.
• Stage I: The cancer has spread into the connective tissue beneath the lining but not into the muscle layer.
• Stage II: The cancer has invaded the muscle wall of the bladder.
• Stage III: The cancer has spread beyond the bladder into surrounding tissues.
• Stage IV: The cancer has spread to distant organs such as the lungs, bones, or liver.

The most common and often earliest symptom of bladder cancer is blood in the urine, known as hematuria. The blood may be visible to the naked eye, making the urine appear pink, rust-colored, or bright red, or it may only be detectable under a microscope during a routine urine test. Blood in the urine often comes and goes, which can lead some people to delay seeking medical attention. This can be a dangerous delay, particularly for women, who may mistake blood in the urine for menstruation or other gynecological causes. Other urinary symptoms can include:

• Having to urinate more frequently than usual
• A sudden, strong urge to urinate that is hard to control
• Pain or a burning sensation during urination
• Difficulty urinating or having a weak urine stream

As the cancer progresses or spreads beyond the bladder, additional symptoms may appear:

• Lower back pain, usually on just one side
• Unexplained weight loss and loss of appetite
• Feeling unusually tired or weak
• Bone pain or tenderness
• Swelling in the feet
• Abdominal pain

If you notice blood in your urine or any of these symptoms, it is important to see a doctor for evaluation. These symptoms do not necessarily mean you have bladder cancer — they can be caused by infections, kidney stones, or other conditions — but they need to be investigated.

Bladder cancer begins when changes occur in the DNA of the cells lining the bladder, causing them to grow and divide uncontrollably. Over time, these abnormal cells can form a tumor and potentially spread to other parts of the body. The exact cause of these DNA changes is not always clear, but several known risk factors significantly increase the likelihood of developing bladder cancer. Smoking is the single most important risk factor, responsible for about half of all bladder cancer cases. Harmful chemicals in tobacco smoke are absorbed into the bloodstream, filtered by the kidneys, and concentrated in the urine. As urine sits in the bladder, these carcinogens come into prolonged contact with the bladder lining, damaging the cells over time. Occupational exposure to certain chemicals accounts for a significant number of cases. People who work with dyes, paints, rubber, leather, printing materials, petroleum products, or diesel fumes have an increased risk. Painters, machinists, printers, hairdressers, and truck drivers are among the occupations with higher exposure. Other risk factors include:

• Chronic bladder inflammation or recurrent urinary tract infections
• Long-term use of urinary catheters
• Previous radiation therapy to the pelvic area
• Treatment with the chemotherapy drug cyclophosphamide
• Long-term use of the diabetes medication pioglitazone (Actos)
• Drinking water contaminated with arsenic
• Infection with schistosomiasis (a parasitic infection common in parts of Africa and the Middle East)
• A family history of bladder cancer or certain genetic conditions

Bladder cancer is more common in men than in women — about four times more common — and the risk increases with age, particularly after age 55. It is also more common in White people than in other racial groups. Having one or more of these risk factors does not mean you will develop bladder cancer, and some people with no known risk factors still develop the disease.

If bladder cancer is suspected based on symptoms or urine test results, several steps are taken to confirm the diagnosis and determine the extent of the disease. Urine tests are often the first step. A urinalysis checks for blood in the urine, and a urine cytology looks for abnormal cells under a microscope. These tests can suggest bladder cancer but cannot confirm it on their own. Cystoscopy is the most important test for diagnosing bladder cancer. A thin, flexible tube with a small camera on the end is inserted through the urethra into the bladder. This allows the doctor to see the inside of the bladder directly and identify any abnormal areas or growths. If suspicious tissue is found during cystoscopy, a biopsy is taken — usually during a procedure called transurethral resection of a bladder tumor (TURBT). This is done under anesthesia and involves removing the tumor or a sample of the abnormal tissue through the urethra. The tissue is sent to a laboratory to be examined for cancer cells. TURBT can also be the first step in treatment for early-stage tumors. Imaging tests help determine whether the cancer has spread beyond the bladder:

• CT scan provides detailed images of the bladder, nearby lymph nodes, and other organs
• MRI scan can show the depth of tumor invasion in the bladder wall
• Intravenous pyelogram (IVP) uses X-rays and contrast dye to view the entire urinary tract
• Chest X-ray checks for spread to the lungs
• Bone scan looks for cancer in the bones

Once the diagnosis is confirmed, the cancer is staged (0 through IV) and graded (low-grade or high-grade) to guide treatment decisions. Low-grade cancers grow more slowly and are less likely to spread, while high-grade cancers are more aggressive.

While bladder cancer cannot always be prevented, several lifestyle measures can significantly reduce your risk. Do not smoke, and if you do smoke, quit. Smoking is the leading preventable cause of bladder cancer. The risk decreases after quitting, and within a few years, your risk is substantially lower than if you continued smoking. Avoiding secondhand smoke is also important. Drink plenty of fluids, especially water. Staying well hydrated helps dilute potentially harmful chemicals in the urine and encourages more frequent urination, which reduces the amount of time any carcinogens are in contact with the bladder lining. Aim for six to eight glasses of water per day. Eat a diet rich in fruits and vegetables. A diet high in colorful fruits and vegetables — particularly cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, and Brussels sprouts — provides antioxidants and other compounds that may help protect bladder cells from damage. If you work with potentially harmful chemicals, take appropriate safety precautions. This includes using protective equipment, following workplace safety guidelines, and minimizing direct exposure to solvents, paints, dyes, petroleum products, and other industrial chemicals. Maintain a healthy weight and stay physically active. Obesity has been linked to an increased risk of several cancers, including bladder cancer. Regular exercise and a balanced diet help maintain a healthy weight and support overall health. If you have a history of chronic bladder infections, long-term catheter use, or other conditions that cause bladder irritation, work with your doctor to manage these conditions and monitor for any concerning changes.

The outlook for bladder cancer depends largely on the stage at which it is diagnosed. When caught early, bladder cancer is highly treatable and the prognosis is excellent. Five-year survival rates by stage:

• Stage 0 (carcinoma in situ): 97 percent
• Localized cancer (confined to the bladder): 71 percent
• Regional spread (to nearby lymph nodes or organs): 39 percent
• Distant metastasis (spread to distant organs such as lungs, bones, or liver): 8 percent

These figures are based on averages from large groups of people and may not reflect any individual’s situation. Your personal outlook depends on many factors, including the type and grade of cancer, your age, your overall health, and how well the cancer responds to treatment. Bladder cancer has a tendency to recur, even after successful treatment. For this reason, people who have been treated for bladder cancer need regular follow-up appointments, including periodic cystoscopies, to monitor for any new tumors. This surveillance is typically continued for several years. The overall five-year survival rate for all stages combined is about 77 percent. This rate has been improving over time as treatments have advanced. Early detection through prompt evaluation of symptoms like blood in the urine offers the best chance of a favorable outcome.

Bladder cancer treatment is tailored to the type, stage, and grade of the cancer, as well as the individual’s overall health and preferences. A multidisciplinary team of specialists typically works together to develop the best treatment plan. Surgery is the most common treatment for bladder cancer. The type of surgery depends on the stage:

• Transurethral resection of bladder tumor (TURBT): Used for early-stage cancers. The tumor is removed through the urethra using a special instrument inserted through a cystoscope. No incisions are needed.
• Partial cystectomy: Only the part of the bladder containing the tumor is removed. This is an option when the tumor is in a single location and has not spread widely.
• Radical cystectomy: The entire bladder is removed, along with nearby lymph nodes and sometimes surrounding organs (prostate in men, uterus and ovaries in women). This is the standard treatment for muscle-invasive bladder cancer. After removal, a urinary diversion is created — a new way for urine to leave the body, either through an opening in the abdomen (urostomy) or by using a piece of intestine to create an internal reservoir.

Chemotherapy can be given in several ways:

• Intravesical chemotherapy: Liquid chemotherapy is placed directly into the bladder through a catheter and left for a period of time. It is often used after TURBT to prevent recurrence in early-stage cancer.
• Systemic chemotherapy: Given orally or intravenously, it travels throughout the body to kill cancer cells. It is often used before surgery to shrink tumors, after surgery to destroy remaining cells, or as the main treatment for advanced cancer.

Immunotherapy helps your own immune system recognize and attack cancer cells:

• BCG (bacillus Calmette-Guérin) therapy: A form of immunotherapy delivered directly into the bladder for early-stage, high-risk bladder cancer. It is very effective at preventing recurrence.
• Checkpoint inhibitors: Given intravenously for advanced bladder cancer that has not responded to chemotherapy.

Radiation therapy uses high-energy beams to kill cancer cells. It may be combined with chemotherapy for people who cannot have surgery or as part of a bladder-sparing treatment plan. Targeted therapy uses drugs that target specific genetic mutations or proteins found in cancer cells. It is used in some advanced cases where testing shows the cancer has certain markers. Clinical trials may be an option for people with advanced bladder cancer, offering access to new treatments still being studied.

While diet alone cannot treat bladder cancer, eating well can support your body during treatment and may help reduce your risk of developing the disease in the first place. Staying hydrated is one of the most important dietary measures for bladder health. Drinking plenty of water dilutes potential carcinogens in the urine and reduces the amount of time they are in contact with the bladder lining. Aim for six to eight glasses of water daily, and more if you are undergoing chemotherapy or radiation. Fruits and vegetables provide antioxidants that help protect cells from damage. Particularly beneficial options include:

• Cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, and Brussels sprouts — these contain sulforaphane, a compound that may help protect bladder cells
• Berries, tomatoes, bell peppers, and leafy greens are rich in vitamins C and E and other antioxidants
• Carrots, sweet potatoes, and squash provide beta-carotene

Whole grains such as oats, brown rice, quinoa, and whole wheat bread provide fiber, which supports healthy digestion and the elimination of waste products from the body. Lean proteins from fish, chicken, beans, and legumes help maintain strength and support the immune system during treatment. Foods to limit:

• Red and processed meats have been linked to an increased risk of bladder cancer in some studies
• Fried and highly processed foods provide little nutritional value and may contribute to inflammation
• Excessive alcohol can interfere with treatment and dehydrate the body

Maintaining a healthy weight is important for overall health and may reduce the risk of recurrence. If you are undergoing treatment, a registered dietitian can help you manage side effects such as nausea, appetite loss, or changes in taste and ensure you are getting the nutrients you need.

Bladder cancer is a disease in which abnormal cells in the lining of the bladder grow uncontrollably, often first appearing as blood in the urine. It is the fourth most common cancer in men and is strongly linked to smoking, which accounts for about half of all cases. Occupational exposure to certain chemicals, chronic bladder inflammation, and a family history of the disease also increase risk. The most common type is transitional cell carcinoma, and the cancer is staged from 0 (confined to the lining) to IV (spread to distant organs). Diagnosis typically involves urine tests, cystoscopy, biopsy, and imaging. Treatment depends on the stage and may include surgery — ranging from tumor removal through the urethra to complete bladder removal — along with chemotherapy, immunotherapy, or radiation. The overall five-year survival rate is approximately 77 percent, and when caught at an early stage, the survival rate reaches 97 percent. Prevention centers on not smoking, staying well hydrated, eating a diet rich in fruits and vegetables, and avoiding exposure to harmful workplace chemicals. With timely diagnosis and appropriate treatment, the outlook for bladder cancer is favorable, particularly for early-stage disease.